Insights

Posted on Thursday, March 9, 2017 1:45 PM

The delay of the new Medicare Conditions of Participation (CoP) rule has created optimism throughout the home health industry, however signs are not as bright regarding changes to the Pre-Claim Review Demonstration (PCRD), according to one of the industry’s most prominent voices in Washington, D.C.

It’s impossible to say what the fate of proposed legislation and pending regulations will be, given that the current atmosphere in the nation’s capital is “chaotic,” William Dombi, Vice President for Law of the National Association for Home Care & Hospice (NAHC), said Wednesday at the Illinois Home Care & Hospice Council annual conference outside Chicago.

Even though Congressional lawmakers and the Trump administration continue their efforts to push forward with the changes to the U.S. health care system, NAHC is busy pursuing other home health objectives that it considers more pressing. For example, their objectives focus on a delay of the CoP rule and to delay the start of the PCR demonstration in Florida.

A Pause on CoPAccording to Dombi, NAHC has requests in with the Centers for Medicare & Medicaid Services (CMS) and Secretary of Health and Human Services (HHS) Tom Price to push back the CoP effective date. In addition, Dombi has a call scheduled with Patrick Conway this Friday to continue the discussion.

“[Conway’s] most recent message was ‘We’re seriously considering a delay in the CoPs,” Dombi said.

While emphasizing that it is only his “impression” that CMS is amenable to a delay, Dombi outlined what he believes is a strong case for pushing back the effective date.

“These CoPs are modernizing where we are with home health standards, not addressing a serious problem [with quality of care],” he said. “If it took 20 years to get to these rules, why are we rushing to an effective date?”Specifically, NAHC is pushing for the effective date to be, at the earliest, six months after the interpretive guidance is issued and surveyor training is complete, Dombi said.

Hope for Pre-Claim Pause LessensNAHC has been working with Price’s office, urging him to use his authority to stop PCR in Illinois and other states, but so far there has been no commitment to do so, Dombi said Wednesday.

“My concern is, day after day, hope of something for Florida diminishes because of time,” he said.

Part of the issue could be that Price is playing the lead role in the administration’s efforts to repeal and replace the Affordable Care Act, Dombi noted.

“In the scheme of his to-do list, what’s at the top, and where is PCR?” Dombi said.

Still, Price’s office says that they are sensitive to the PCR timeline, and NAHC believes they are “engaged” on the issue, according to Dombi.

The association also is in discussions with CMS to step back in Illinois and take a more targeted approach, to focus pre-claim review on agencies with lower affirmation rates rather than continuing to subject successful providers to the program’s requirements. CMS is “thinking about it, looking at the data,” Dombi said.

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